Authoritative Report Suggests More Than 1-in-4 GP Appointments are Unnecessary

A new report suggests that needless bureaucracy is putting unnecessary pressure on GP appointments across the UK.

The report in question argues that as many as 27 per cent of GP appointments are ultimately avoidable.

The Making Time In General Practice study by NHS Alliance and the Primary Care Foundation suggest that one-in-four GP appointments could potentially be avoided if superior coordination between GPs and hospitals was carried out.

In addition, the report indicates that wider use of other primary care staff, better use of technology to streamline administrative burdens, and wider system changes could also have a positive impact on the existing situation.

The report was commissioned as part of the work that NHS England is currently carrying out with partner organisations as part of the implementation of the highly publicised NHS Five Year Forward View.

This prestigious report was also overseen by a steering group including the Royal College of GPs and the BMA GPs’ Committee.

There is a particular emphasis within the NHS Five Year Forward View of expanding and strengthening AGP services and primary care across England.

And with this in mind, the report finds that a significant amount of GP time could be freed up if family doctors were not having to spend time rearranging hospital appointments, and chasing up test results from local hospitals.

It is also estimated by the report that around 16 per cent of the patients in the study could potentially have been seen by someone else in the wider primary care team, such as clinical pharmacists, practice nurses or physician assistants, or by being supported to meet their own health needs.

A further 4 per cent of appointments might have been dealt with through social prescribing / navigation.

The study also suggest several practical steps that could be implemented in order to cut down on bureaucracy.

These include:

– offering patients who are unable to attend hospital appointments the ability to rebooked within two weeks without visiting a GP for a needless second appointment;

– employing a wider range of staff within the practice team;

– streamlining communication, particularly between hospitals and practices;

– GP federations should be funded to work across their practices to build practical social prescribing projects.

Commenting on the findings of the report, Dr Jonathan Serjeant, GP, co-director and co-founder of Brighton and Hove Integrated Care Service and National lead for NHS Alliance’s Accelerate programme, stated that the study provided some valuable insight in improving the working roles of GPs across England.

“GPs and their colleagues are experts in listening, supporting and diagnosing their patients. This is what we’ve been trained to do, and what we want to do. If applied quickly, the recommendations set out in this report, particularly those around extending the GP team to incorporate other health professionals, will help reduce the current levels of bureaucracy GPs face on a daily basis. The end result is that GP time is freed up, and people have access to all their information whenever they need it,” Serjeant observed.

Rick Stern, chief executive of NHS Alliance, and a director of the Primary Care Foundation added: “This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden. We want to ensure that GPs and their colleagues in general practice are freed up to deliver the job they were trained to do and care so passionately about.”

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Investigation Finds GPs Being Paid to Reduce Hospital Referrals

According to a recent investigation, a raft of general practitioners in England are being offered significant sums of money in order to cut the numbers of patients being referred to hospitals.

The investigation carried out by Pulse found that some doctors are being offered thousands of pounds as an incentive to make such decisions.

Naturally this is incredibly controversial considering that patients should simply be referred for hospital treatment based on its necessity or otherwise.

But the doctors’ publication Pulse found that GP practices across the country are being paid in order to help local NHS groups limit the overall number of patient referrals.

Rather than being a logistical issue, this is seen as being a cost-cutting exercise, according to the publication.

Among the issues being deferred were scans and consultations with specialists, and most troublingly these even included cancer patients.

Despite the seriousness of the allegations made by the Pulse survey, this was found to be a relatively widespread practice.

At least nine clinical commissioning groups (CCGs) were offering GP practices payments for hitting targets, according to Pulse’s investigation.

Perhaps the most notable case discovered by the publication related to Birmingham South Central CCG.

This particular clinical commissioning group was offering practices in excess of £11,000 in order to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions.

The CCG even set a target of reducing figures by 1 per cent compared with the previous financial year.

While Pulse found that the scheme run by the Birmingham organisation could be attributed to fiscal motivations, the organisation has defended itself since the allegations came to light.

The Birmingham South Central CCG stated that the program of payments was intended to “incentivise best quality practice” and “drive improvements in the quality of primary medical care”, with a spokesperson on behalf of the organisation suggesting that the priority of the organisation “is to ensure that patients have access to services that they need, when they need them.”

Elsewhere, another organisation suggested that the full impact of the scheme had been considered diligently before it was put in place, and the CCG believes that there is no conflict in trust inherent in the programme.

Nonetheless, despite the rhetoric from the CCGs, many people will undoubtedly view the payment of general practitioners to refuse referrals as being a disturbing and sinister development.

And the news has drawn harsh, but what many will see as warranted, criticism from prominent medical figures.

Dr Chand Nagpaul, chairman of the GPs committee of the doctors’ trade union the British Medical Association, described the scheme as a “financial contaminant” to patient-doctor trust.

“It’s short-sighted and misguided of CCGs to introduce such mechanisms, because they do lead to the potential for patients questioning the motives of GP referrals. We believe it is far more appropriate for CCGs to introduce clinical pathways that ensure patients are referred appropriately rather than these crude, salesman-like bonuses which pay GPs simply to make reduction to referrals in numerical terms,” Nagpaul stated.

The outcome of the investigation by Pulse can be placed in the context of pressure being placed on the NHS to make efficiency savings.

£22 million of such savings have been targeted by the government by the end of the decade.

But many will view this news as indication that the balance between efficiency and medical ethics is not being conducted appropriately.

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Report Paints Bleak Picture of London GP Network

A new report submitted to the House of Commons indicates that GP surgeries in London are teetering on the brink of breaking point.

The Londonwide Local Medical Committees (LLMC) – a group that operates the statutory bodies that serve GPs in 27 of the 32 boroughs – specifically describes the situation as at “saturation point”.

According to the report, it is impossible for the existing network of GP surgeries to provide any further care to patients.

The LLMC indicates that representatives of 7,000 GPs at 1,300 practices spread across London already claim that they are unable to cope with existing demand.

This is already serious enough in itself, but with the population of London expected to increase significantly to 9.2 million by the end of the decade – an increase of over 500,000 – the problem is set to be exacerbated further.

A wide variety of cuts to critical programmes have ensured that surgeries now represent a “revolving door of consultations”.

This worrying picture forms the centrepiece of a report that has been submitted to the House of Commons.

The study was requested by the Health Select Committee, as the parliamentary body continues to investigate the growing pressure on family doctors and primary care.

Critics of government policy will be unsurprised by the picture painted by the organisation.

Furthermore, the problems that GP surgeries are facing in London will increasingly call into question the plans of Prime Minister David Cameron to create a seven-day culture in the NHS.

Far from having the potential to expand existing operations, the report instead suggested that the health service is already failing to deliver its current modus operandi.

Aside from the pressure on NHS provisions, the negative human impacts of stretching resources to this extent was also documented by the report.

It suggests that “in deprived areas, GPs are seeing patients in their mid-40s with multiple long-term conditions … which would normally only be present in those over 70,” but have only 10-minute appointments in which to help them.”

Further aggravating the difficulties is the fact that the capital is currently facing a wave of GP surgery closures.

Health service plans would see as many as 140 surgeries put at risk over the next three years.

Although the situation in London may be considered indicative of the UK as a whole, it is important to emphasise that the capital has its own specific difficulties.

Health infrastructure in London is often complex, and other factors such as outdated premises and the steady phasing out of NHS subsidies to GP practices has had a serious impact on services being delivered in the UK’s capital city.

Dr Michelle Drage, chief executive of Londonwide LMCs, stated with regard to the health situation in the capital that “it’s reckless and shortsighted to stop providing support services in the community such as health visitors, mental health services and social services because they get overwhelmed and telltale signs of illness get missed.”

Drage also asserted that the current plans were leading to “GPs having more consultations, less time with patients, and patients waiting longer for appointments. Everybody gets a worse deal. Too many GPs and practice nurses in London are running on empty trying to manage these rises in demand.”

In response, a spokeswoman for NHS England suggested that efforts were being made to increase the number of active GPs in the UK.

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